Relation between BMI and diabetes mellitus and its complications among US older adults.

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OBJECTIVES: This study examined relations between elevated body mass index (BMI) and time to diagnosis with type 2 diabetes mellitus and its complications among older adults in the United States. METHODS: Data came from the Medicare Current Beneficiary Survey, 1991-2010. A Cox proportional hazard model was used to assess relations between excess BMI at the first Medicare Current Beneficiary Survey interview and time to diabetes mellitus diagnosis, complications, and insulin dependence among Medicare beneficiaries, older than 65 years of age with no prior diabetes mellitus diagnosis, and who were not enrolled in Medicare Advantage (N = 14,657). RESULTS: Among individuals diagnosed as having diabetes mellitus, elevated BMIs were associated with a progressively higher risk of complications from diabetes mellitus. For women with a BMI ≥40, the risk of insulin dependence (hazard ratio [HR] 3.57; 95% confidence interval [CI] 2.36-5.39) was twice that for women with 25 ≤ BMI < 27.5 (HR 1.77; 95% CI 1.33-2.33). A similar pattern was observed in risk of cardiovascular (25 ≤ BMI < 27.5: HR 1.34; 95% CI 1.15-1.54; BMI ≥40: HR 2.45; 95% CI 1.92-3.11), cerebrovascular (25 ≤ BMI < 27.5: HR 1.30; 95% CI 1.06-1.57; BMI ≥40: HR 2.00; 95% CI 1.42-2.81), renal (25 ≤ BMI < 27.5: HR 1.31; 95% CI 1.04-1.63; BMI ≥40: HR 2.23; 95% CI 1.54-3.22), and lower extremity complications (25 ≤ BMI < 27.5: HR 1.41; 95% CI 1.22-1.61; BMI ≥40: HR 2.95; 95% CI 2.35-3.69). CONCLUSIONS: Any increase in BMI above normal weight levels is associated with an increased risk of being diagnosed as having complications of diabetes mellitus. For men, the increased risk of these complications occurred at higher BMI levels than in women. Ocular complications occurred at higher BMI levels than other complication types in both men and women.





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Gray, Natallia, Gabriel Picone, Frank Sloan and Arseniy Yashkin (2015). Relation between BMI and diabetes mellitus and its complications among US older adults. South Med J, 108(1). pp. 29–36. 10.14423/SMJ.0000000000000214 Retrieved from

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Frank A. Sloan

J. Alexander McMahon Distinguished Professor Emeritus of Health Policy and Management

Professor Sloan is interested in studying the subjects of health policy and the economics of aging, hospitals, health, pharmaceuticals, and substance abuse. He has received funding from numerous research grants that he earned for studies of which he was the principal investigator. His most recent grants were awarded by the Robert Wood Johnson Foundation, the Center for Disease Control, the Pew Charitable Trust, and the National Institute on Aging. Titles of his projects include, “Why Mature Smokers Do Not Quit,” “Legal and Economic Vulnerabilities of the Master Settlement Agreement,” “Determinants and Cost of Alcohol Abuse Among the Elderly and Near-elderly,” and “Reinsurance Markets and Public Policy.” He received the Investigator Award for his work on the project, “Reoccurring Crises in Medical Malpractice.” Some of his earlier works include the studies entitled, “Policies to Attract Nurses to Underserved Areas,” “The Impact of National Economic Conditions on the Health Care of the Poor-Access,” and “Analysis of Physician Price and Output Decisions.” Professor Sloan’s latest research continues to investigate the trends and repercussions of medical malpractice, physician behavior, and hospital behavior.


Arseniy Yashkin

Research Scientist, Senior

I am primarily a health outcomes researcher who specializes in cancers and chronic age-related diseases, especially Alzheimer’s disease and type II diabetes mellitus.  However, I also write in epidemiology, demography, health economics and genetics.  I am a specialist in the analysis of administrative big health data.   My main contributions to scholarship can be summarized across three focus areas: health outcomes research, epidemiology and methodology, and health economics.  Some of my most important findings are described below.

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